摘要: |
目的 探讨老年冠心病患者行经皮冠状动脉介入(percutaneous coronary intervention,PCI)术发生造影剂肾病(contrast induced nephropathy,CIN)的危险因素。方法 分析2015年1月至2017年12月于复旦大学附属中山医院心内科住院行PCI术的378例老年冠心病患者的临床资料,包括基本资料、合并症、实验室指标以及药物治疗,采用单因素分析和多因素分析找出发生CIN的危险因素,采用Kaplan-Meier曲线分析CIN对再住院的影响。结果 378例老年冠心病患者中有58例(15.3%)发生CIN。多因素分析结果显示,术前肌酐(P=0.010,OR=0.721,95% CI 0.622~0.834)、术后肌酐(P=0.023,OR=1.207,95% CI 1.094~1.332)、肾小球滤过率(P=0.024,OR=0.755,95% CI 0.630~0.905)以及应用利尿剂(P=0.032,OR=1.206,95% CI 0.904~1.364)是导致老年冠心病患者行PCI术发生CIN的重要危险因素。生存曲线显示,CIN的发生显著增加老年冠心病患者PCI术后再住院率(P=0.000 9,HR=2.359,95% CI 1.192~4.668)。结论 围手术期较高的肌酐、较低的肾小球滤过率以及应用利尿剂是导致老年冠心病患者行PCI发生CIN的重要危险因素。 |
关键词: 老年冠心病 经皮冠状动脉介入术 肌酐 造影剂肾病 危险因素 |
DOI:10.12025/j.issn.1008-6358.2022.20220254 |
分类号:R541.4 |
基金项目:基于QFD优化全生命周期药学服务(qcc202203). |
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Risk factors of contrast induced nephropathy in elderly patients with coronary artery disease |
QIU Qi-ning1, LI Xiao-ye1, WANG Zhen-fang2, YE Yan-rong1, WANG Qing-le3
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1.Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2.Department of Cardiology, Zhongshan Hospital (Xiamen Branch), Fudan University, Xiamen 361015, Fujian, China;3.Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
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Abstract: |
Objective To explore the risk factors of contrast induced nephropathy (CIN) in elderly patients with coronary heart disease undergoing the percutaneous coronary intervention (PCI). Methods The clinical data of 378 elderly patients who underwent PCI in Zhongshan Hospital, Fudan University from January 2015 to December 2017 were selected, including basic data, complications, laboratory indicators and therapy to analyze the risk factors of contrast induced nephropathy by univariate and multivariate methods. Kaplan-Meier was used to analyze the effect of CIN on re-hospitalization rate. Results CIN occurred in 58 of 378 elderly patients with coronary heart disease. Multivariate analysis showed that the preoperative creatinine (P=0.010, OR=0.721, 95%CI 0.622-0.834),the postoperative creatinine (P=0.023, OR=1.207, 95%CI 1.094-1.332), the glomerular filtration rate (P=0.024, OR=0.755, 95%CI 0.630-0.905), and the application of diuretics (P=0.032, OR=1.206, 95%CI 0.904-1.364) were the important risk factors of contrast induced nephropathy in elderly patients with coronary heart disease undergoing PCI. Kaplan-Meier showed that the occurrence of CIN would significantly increase the re-hospitalization rate of elderly patients with coronary heart disease after PCI (P=0.000 9, HR=2.359, 95%CI 1.192-4.668). Conclusion The preoperative and postoperative creatinine, the glomerular filtration rate and diuretics are important risk factors of CIN in elderly patients with coronary heart disease undergoing coronary angiography. |
Key words: elderly patients with coronary heart disease percutaneous coronary intervention creatinine contrast induced nephropathy risk factors |